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Biomedical subjects

E Eschwege

Publications and source records attributed to E Eschwege.

At least 37 records · Page 2Linked to original sources
PubMed1998

Medico-economic analysis of diacerein with or without standard therapy in the treatment of osteoarthritis.

This 9-month pragmatic study compared 2 therapeutic regimens in the management of osteoarthritis of the hip and knee. Patients received either diacerein 100 mg/day plus standard osteoarthritic therapy for 6 months, followed by a 3-month monitoring period without diacerein, or standard therapy alone for the entire 9-month period. A total of 207 patients with osteoarthritis of the knee and hip were enrolled. Improvements in Lequense's functional index and quality-of-life scores (revised Arthritis Impact Measurement Scales Health Status Questionnaire and Nottingham Health Profile), and decreases in nonsteroidal anti-inflammatory drug and analgesic consumption were significantly greater with diacerein plus standard therapy than with standard therapy alone. The overall assessment of therapy by patients was good or excellent for 60% of those who received diacerein plus standard therapy, compared with 26% who received standard therapy alone. Medical and paramedical procedures carried out in addition to those stipulated in the protocol (medical consultations, physiotherapy, nursing, etc.), osteoarthritis-related, were fewer and less costly in the diacerein plus standard therapy group than in the standard therapy group. The average outpatient cost (in 1995 French francs) of osteoarthritis treatment in the standard therapy group was FF2272 compared with FF2360 in the diacerein plus standard therapy group. The cost-effectiveness ratios per point scored on Lequesne's index were FF1893 for the standard therapy group and FF1072 for the diacerein plus standard therapy group, leading to a saving of 43% with diacerein plus standard therapy. The marginal cost (additional cost corresponding to the clinical benefit obtained by adding diacerein to standard treatment) was FF88 per point scored on Lequesne's index.

Aged↗
PubMed1998

Insulin dose and cardiovascular risk factors in type 1 diabetic children and adolescents.

Associations between a high daily insulin dose and cardiovascular risk factors, including those of the insulin-resistance syndrome, were studied in 479 Type 1 diabetic children 6 to 18 years of age. Insulin dose increased over the first two years after diagnosis of diabetes (p = 0.0001) and was significantly higher in girls (p = 0.01). For those children with diabetes duration of more than 2 years, the insulin requirement increased up to 13-14 years of age (p < 0.05) and was higher in pubertal than pre-pubertal children (p < 0.05). For girls, the requirement was higher in puberty than in post-puberty (p < 0.05) and increased with diabetes duration (p < 0.05). Triglyceride concentrations were associated positively and significantly with the insulin dose of both boys and girls, after adjustment for age, pubertal stage, diabetes duration, and metabolic control (fructosamine levels). No other consistent associations were found between insulin dose and other cardiovascular risk factors: body mass index, central adiposity, arterial blood pressures, serum total cholesterol, apoA1, apoB, Lp(a), uric acid, or urinary albumin excretion. Parental obesity, hypertension and diabetes were not related to the insulin dose of children. The results did not differ when the population was limited to the 375 children with diabetes duration of more than 2 years. It is concluded that in these Type 1 diabetic children the insulin dose for a given level of metabolic control (our surrogate measure of insulin resistance) was related to a single cardiovascular risk factor: triglyceride concentrations.

Adolescent↗
PubMed1997

Ischemic heart disease and alcohol-related causes of death: a view of the French paradox.

PURPOSE: In France the low rates of death due to ischemic heart disease have been attributed to the high consumption of alcohol. However, the question remains: are the higher death rates for causes associated with alcohol consumption an explanation? METHODS: Diseases were defined according to the International Classification of Diseases, revision 9. World Health Organization data on country- and age-specific death rates were used. RESULTS: Official causes-of-death statistics for men 40-74 years of age show that in 1990 French men under 50 years old had low death rates from ischemic heart disease but a relatively high all-cause mortality rate, in contrast to low rates for men 60 to 74 years of age. Among French men aged 40-44 years in 1960, 34% had died before reaching the age of 70-74 years. In comparison, 37% in the United States and 36% in England and Wales, had died by this age, with 4.5%, 14.1%, and 15.2% of deaths, respectively, due to ischemic heart disease. If all of the men who died early of causes associated with alcohol had died of ischemic heart disease, there would still be a lower rate in France (21%) than in the United States (26%) or in England and Wales (25%). CONCLUSION: Thus, although some of the chronic heavy drinkers in France die early of causes associated with excessive alcohol consumption, this is not the only reason for the low ischemic heart disease death rates.

Adult↗
PubMed1997

Association between plasma total testosterone and cardiovascular risk factors in healthy adult men: The Telecom Study.

The associations between androgens and cardiovascular risk factors in men are controversial. A nested case-control study was used to compare the levels of cardiovascular risk factors in two groups (n = 25 each) of healthy men contrasted by their plasma total testosterone (PTT) concentration, matched by age and ethnic origin. Compared to the men with normal PTT (mean +/- SEM, 19.8 +/- 0.7 nmol/L), the men with low PTT (10.1 +/- 0.3 nmol/L) had a significantly higher body mass index (P < 0.01), waist/hip ratio (P < 0.001), systolic blood pressure (P < 0.05), fasting and 2-h plasma glucose (P < 0.04 and P < 0.02 respectively), serum triglycerides (P < 0.001), total cholesterol (P < 0.04), low density lipoprotein cholesterol (P < 0.01), apolipoprotein B (P < 0.01), fasting and 2-h plasma insulin (both P < 0.0001), and lower values of serum high density lipoprotein cholesterol (P < 0.01) and apolipoprotein AI (P < 0.05). After adjustment for both body mass index and waist/hip ratio, fasting and 2-h plasma insulin and triglyceride levels remained significantly different between the two groups (P < 0.04, P < 0.001, and P < 0.03 respectively). Plasma sex hormone-binding globulin was markedly decreased in the low PTT group (P < 0.0001), whereas bioavailable testosterone was not significantly different. This case-control study provides further and stronger evidence of a negative association between PTT and plasma insulin in men, as suggested by cross-sectional studies. Because these are observational data, neither causality nor the direction of the associations among PTT, sex hormone-binding globulin, and insulin sensitivity can be determined. Intervention studies are needed to better assess the metabolic and cardiovascular benefits of androgen treatment that have been suggested by preliminary clinical trials.

Biological Availability↗
PubMed1997

A pragmatic cost-effectiveness study of routine epidural corticosteroid injections for lumbosciatic syndrome requiring inhospital management.

A multicenter randomized study was conducted using a pragmatic approach to evaluate the benefits and costs of routine epidural corticosteroid injections for the treatment of lumbosciatic syndrome requiring inhospital management. The primary evaluation criterion was whether other treatments were required after one to three injections. The 108 patients were randomly allocated to treatment with or without routine epidural corticosteroids. Rest and a nonsteroidal antiinflammatory drug were used in all patients. The two groups were comparable at baseline except for a larger proportion of males in the routine epidural corticosteroid group. Patients in the routine epidural corticosteroid group were more likely to require other treatments, but the difference was only of borderline significance after adjustment for gender. Results showed that physicians based their treatment decisions primarily on whether an improvement in the clinical status of the patient was apparent at the second visit. None of the other factors studied influenced treatment decisions. Clinical efficacy criteria were identical in the two groups. Hospital costs contributed most of the total cost, and the mean cost was higher in the routine epidural corticosteroid group. These data suggest that adding an epidural injection as a first-line treatment to rest and a nonsteroidal antiinflammatory drug for the treatment of lumbosciatic syndrome requiring inhospital management results in additional costs and no gain in efficacy.

Adolescent↗
PubMed1997

Proposed criteria for the diagnosis of diabetes: evidence from a French epidemiological study (D.E.S.I.R.).

The American Diabetes Association and a working group of the International Diabetes Federation and the World Health Organisation are considering the possibility of lowering the level of fasting glucose for diagnosis of diabetes from 7.8 mM to 7.0 mM (126 mg/dl) and adding a "hyperglycaemia" category (6.1-6.9 mM). This report studied the resulting change in the frequency of diabetes in the French D.E.S.I.R. cohort and evaluated cardiovascular risk factors according to the proposed limits. The frequency of treated diabetes was 1.0% in this cohort of more than 5,000 French men and women 30 to 64 years of age, 0.7% had a fasting glucose > or = 7.8 mM versus 1.6% for the proposed > or = 7.0 mM. Using the new criteria, 3.8% of men and 1.6% of women would be diabetic. For many cardiovascular risk factors, men with fasting glucose > or = 7.8 mM had a significantly higher risk than those in the (7.0-7.7 mM) range, whereas no significant differences were found for women. There were few differences between the (7.0-7.7 mM) and (6.1-6.9 mM) ranges, but highly significant differences were apparent for both sexes between the normoglycaemic (< 6.1 mM) and hyperglycaemic (6.1-6.9 mM) categories. The percentage of men with two or more of ten risk factors increased with fasting glucose: 36% in the normoglycaemic (< 6.1 mM) and 49% in the hyperglycaemic (6.1-6.9 mM) categories; 73% with fasting glucose in (7.0-7.7 mM) versus 90% with fasting glucose > or = 7.8 mM. In women, the corresponding percentages were lower: 26% and 60%, 32% versus 64% respectively. The major increase in cardiovascular risk factors would appear to occur at 6.1 mM, for men, whereas the increase in the combination of risk factors was at the more conservative cut-off of 7.0 mM.

Adult↗
PubMed1996

Effect of maternal diabetes on the pattern of selected insulin resistance syndrome parameters in normal glucose tolerant subjects of two Algonquin Indian communities in Quebec.

OBJECTIVE: To determine whether a maternal antecedent with diabetes has an effect on insulin resistance syndrome parameters. RESEARCH DESIGN AND METHODS: We studied 352 Algonquin Indians from Quebec aged at least 15 years who had no personal antecedents with diabetes. Data concerned clinical and biological parameters and the parental antecedents with diabetes. RESULTS: For subjects over > 30 years, fasting insulin and cholesterol levels were significantly higher in the group with a maternal history of diabetes than in the group with a paternal history. Significant differences were observed for serum triglyceride, BMI, and subscapular skinfold thickness when comparing subjects with a maternal history and those with no parental history of diabetes. Blood pressure and fasting glucose did not differ according to parental history. CONCLUSIONS: Subjects of maternal antecedents with diabetes have known risk factors for NIDDM. This study does not identify whether there is a genetic or maternal environmental reason for this association.

Adolescent↗
PubMed1996

Arterial hypertension in the adult population of Guadeloupe, and associated factors in subjects of African origin.

This study was designed to estimate the prevalence of hypertension in Guadeloupe, the French West Indies, and to evaluate the risk factors associated with hypertension in the largest ethnic group, that of African origin. Households were randomly selected using a two-stage systematic sample of districts and then of houses; all adults aged 18 years in the household were included. In total, 1043 men and women were studied. Blood pressure, plasma glucose concentrations and gamma-glutamyl transferase activity were measured, hypertensive treatment and lifestyle factors recorded. The prevalence of hypertension, age-standardized to the Guadeloupe population was 21% and 26% in men and women of African origin, 28% and 22% in those of Indian-origin and 18% and 16% for other origins. The vast majority of subjects were unaware of their hypertension (90% of men, 74% of women). After adjustment for age, factors associated with high blood pressure in the 826 adults of African origin were: obesity, hyperglycemia, low educational level and family history of hypertension and of stroke. Additional factors in women were alcohol consumption, gamma-glutamyl transferase activity, physical inactivity, occupational category and a retired status, even after adjustment for age. Measures must be taken to diagnose hypertension early, particularly in individuals of African and Indian origin. An effective education program is needed, with an emphasis on life-style factors associated with obesity: diet and physical activity.

Adolescent↗
PubMed1995

National study of obliterative arterial disease of the lower limbs involving general practitioners in France: Artemio study.

A national survey was performed in France from May to June, 1993. The aim of this study was to evaluate general practitioners' attitudes and behaviors when diagnosing and managing patients with lower extremity arterial disease (LEAD). One thousand general practitioners, randomly drawn from an exhaustive list, were contacted to participate in a telephone interview concerning the last patient with intermittent claudication seen in their practice. Four hundred seventy-six general practitioners participated. Risk factors noted for these 476 patients with intermittent claudication were in agreement with the literature: 86% were men aged 64 +/- 10 years (mean +/- SD) and 14% were women aged 73 +/- 8 years. Sixty-two percent had a pain-free walking distance of between 100 and 500 meters at diagnosis. Forty-five percent were former smokers and 37% currently smoked; 55% had hypertension, 14% diabetes, and 56% disturbances of lipid metabolism. A majority of them were hypercholesterolemic. The diagnosis of the disease was based primarily on a clinical assessment, confirmed for 33% by Doppler or echo Doppler. The mean duration of diagnosis was 4.4 +/- 4.1 years. Management of the disease was mainly by prescription of vasodilators (91%), antiplatelet agents (59%), and anticoagulants (8%). Use of Doppler or echo Doppler was recommended once a year. Infection was observed in 27% of patients. Thirty-eight percent had had a cardiac incident (angina pectoris or myocardial infarction) and 10% a cerebrovascular accident. They differed significantly from those with LEAD alone for the following parameters: age (68.5 +/- 9.2 vs. 63.2 +/- 10.3 years; p < 0.001); duration of LEAD (5.6 +/- 4.6 vs. 3.6 +/- 3.5 years; p < 0.001); hypertension (65% vs. 50%; p < 0.01); and current smoking (29% vs. 43%; p < 0.01). This survey confirmed the feasibility of telephone interviewing, on a large sample of general practitioners in France. The high level of association with other cardiac incidents was, for these patients, a much higher risk of mortality and morbidity than LEAD alone. It would be interesting to validate the associations observed with a prospective study of comorbidity.

Adult↗
PubMed1995

Risk factors and their identification second part: study designs for identification of risk factors.

This is the second a series of three articles which reviews the identification of risk factors of a disease, here: diabetes or complications of diabetes. In the first of the series [1], we gave the definition of a risk factor, along with measures of its force-relative risk and odds ratio, followed by the epidemiological definitions of the diseases: diabetes, coronary heart disease and hypertension. Risk factors were further discussed and we completed the discussion by some observations on the bias which can arise from a study or from its analysis, which can lead the researcher to the wrong conclusion. In this second article we define the three types of epidemiological studies which are used to determine whether factors are associated with a disease: observational or cross-sectional studies, cohort studies and casecohort studies. Examples are provided of each of these study types; their advantages and disadvantages are discussed. The final paper will provide some examples of the identification of risk factors from the literature. The first example involves diabetes and pancreatic cancer, the second birth weight and non-insulin dependent diabetes. Having found an association between a risk factor and diabetes, we will discuss whether it can be considered to be a risk factor, and if so whether it is likely to be a cause of the disease.

Case-Control Studies↗
PubMed1995

Risk factors and their identification. First Part: What is a risk factor?

This series of three articles reviews the designs of studies which can be used to identify risk factors of a disease, here: diabetes or complications of diabetes. In the present issue of Diabete & Metabolisme, the first article of the series, we give the definition of a risk factor, along with measures of its force--relative risk and odds ratio, followed by the epidemiological definitions of the diseases: diabetes, coronary heart disease and hypertension. Risk factors are further discussed and we complete the discussion by some observations on the bias which can arise from a study or from its analysis, which can lead the researcher to the wrong conclusion. The three types of epidemiological studies which are used to determine whether factors are associated with a disease: observational or cross-sectional studies, cohort studies and case-cohort studies will be described in the second of the series in the next issue of the journal. Examples will be provided of each of these study types; their advantages and disadvantages will be discussed. In a third issue, the final paper will provide some examples of the study types and the identification of risk factors. The first examples involve diabetes and pancreatic cancer, the second birth weight and non-insulin dependent diabetes. Having found an association between a risk factor and diabetes, then we will discuss whether it can be considered to be a risk factor and if so and whether it is likely to be a cause of the disease.

Adult↗
PubMed1995

Risk factors and their identification. Third Part: Examples.

This is the final of a series of three articles in Diabete & Metabolisme which reviews the identification of risk factors of a disease, here: diabetes or complications of diabetes. In the first of the series [1], we gave the definition of a risk factor, along with measures of its force-relative risk and odds ratio, followed by the epidemiological definitions of the diseases: diabetes, coronary heart disease and hypertension. Risk factors were further discussed and we completed the discussion by some observations on the bias which can arise from a study or from its analysis, which can lead the researcher to the wrong conclusion. The three types of epidemiological studies which are used to determine whether factors are associated with a disease: observational or cross-sectional studies, cohort studies and case-cohort studies are described in the second of the series [2]. Examples were provided of each of these study types and their advantages and disadvantages were discussed. This final paper provides some examples of the study types and the identification of risk factors from the literature. The first examples involve diabetes and pancreatic cancer, the second birth weight and non-insulin dependent diabetes. Having found an association between a risk factor and a disease, we then discuss whether it can be considered to be a risk factor, and if so and whether it is likely to be a cause of the disease.

Adult↗
PubMed1994

Epidemiology of peripheral arterial disease.

With the aging of the population of most developing nations, arteriosclerosis is becoming a major health problem. Although much research has concentrated on the coronary and cerebral forms of the disease, peripheral arterial disease has received little attention from epidemiologists. The "Rose questionnaire" has been used extensively to diagnose intermittent claudication; however, the current method of choice for the diagnosis of peripheral arterial disease in epidemiologic studies is the ankle brachial pressure index. The prevalence of intermittent claudication, diagnosed by the Rose questionnaire, differs according to age, sex, and geographical location varying between 0.4 and 14.4%; similar variability (from 4.2 to 35%) is seen for disease diagnosed by the ankle brachial pressure index. The major risk factor for peripheral arterial disease is cigarette smoking; hypertension and diabetes have been identified as risk factors in a number of studies; impaired glucose metabolism, dislipidemia, degree of physical activity, and coagulation factors have been identified in some populations. The coexistence of cardiocerebrovascular and peripheral vascular diseases enhances the risk of early death, which is more than double that in the general population: The most frequent cause of death is myocardial infarction. More work is required to document the natural history of the disease, the risk factors for its progression, its relationship with cardiovascular disease, and the effect of intervention strategies.

Age Factors↗
PubMed1992

Features of insulin-resistance syndrome in men from French Caribbean Islands. The Telecom Study.

The prevalence of diabetes is known to be high in the West Indies, whereas CVD seems relatively rare. This apparently contradicts the existence of the insulin-resistance syndrome, a cluster of metabolic abnormalities supposedly favoring both diabetes and cardiovascular complications. To address the question of whether this contradiction could be accounted for by specific features of this syndrome, we compared 1505 Caucasian and 181 Afro-Caribbean men, all participants in the French Telecom Study. The Afro-Caribbeans were of the same age and had the same BMI as the Caucasians; they also had significantly higher subscapular skin-fold thickness and fasting insulin level, but similar BP and blood glucose level, and significantly lower plasma triglyceride level. Thus, although some features of the insulin-resistance syndrome were present (central adiposity and high insulin levels), none of the associated metabolic abnormalities were present. However, within the Afro-Caribbean group, subjects with plasma insulin concentrations above the median (> 52 pM) had higher mean BP and glucose and triglyceride levels compared with subjects with insulin concentrations < or = 52 pM (P < 0.001). After adjustment for age and BMI, these differences, though smaller, still were statistically significant. These findings confirm that higher insulin concentrations are associated with higher levels of potentially atherogenic and diabetogenic metabolic parameters. However, depending on ethnic origin, the mean levels of these parameters seem to be different, with the consequence that, even if they are elevated with increasing insulin levels, they may not reach values high enough to determine a substantial risk of disease.

Adult↗